Health is unlikely to be at the top of the list of subjects that David Cameron wants to talk about in the coming months – even though our recent poll showed that he leads Ed Miliband on it. Whereas five years ago images of the then Leader of the Opposition were adorning billboards nationwide proclaiming that he would “cut the deficit, not the NHS”, today the situation is somewhat different.

Then, Cameron was the insurgent challenger to an unpopular and unloved prime minister. Voters were willing to give him a hearing – even on that most un-Conservative of issues, the health service.

Now, as Prime Minister, entering the final stretch of a five-year parliament, he is having to defend the charge from Labour opponents of doing the very thing he said he wouldn’t – making damaging cuts to the NHS. The truth in this allegation is contestable, but what is clear is that opposition attacks continue to achieve traction with voters: there is little sign from polls overall that Labour is about to lose its lead as the party most trusted on the NHS.

This presents a strange paradox for the Conservatives: at October’s Party conference, Jeremy Hunt pledged that a future Conservative government would have “no greater priority than to protect, support and invest in our NHS”. Yet with the party’s management of the health service viewed dimly by the public, it is difficult to see how this vision can be fleshed out in any meaningful way during a bruising general election campaign. At the national level, at least, it is a fairly safe bet that we won’t be seeing the Prime Minister making any major play on the Party’s NHS record.

At the local level, the issue might not be so easily avoided. We know that Cameron’s ability to return to Downing Street depends on how many marginal seats he can retain in the Conservative column. We also know that health is almost certain to be in the top three of voters’ concerns when they are making their choices come May. Hunt’s recent revelation that he took his children to the local A&E instead of waiting for a GP appointment demonstrated the importance of local hospital services.

It also demonstrated the pressures they face. Like it or not, hospitals have the potential to be used as political footballs: the success of Dr Richard Taylor’s campaigns in Wyre Forest during the last decade provided apt demonstration of this. Hospitals could make or break many local campaigns this year, too. With a view to this, Incisive Health has identified 15 hospitals which could potentially decide the outcome of the election.

Eleven of these hospitals are in Conservative held seats. All could potentially play influential roles in determining how wavering voters make their final decisions.

Six of the hospitals have been judged by the CQC and Monitor to be failing in one or more important respects following rigorous inspection programmes (Blackpool Victoria Hospital – Blackpool North and Cleveleys; Cumberland Infirmary, Carlisle – Carlisle; Lincoln County Hospital – Lincoln; Royal Cornwall Hospital – Truro and Falmouth; Royal Lancaster Infirmary – Lancaster and Fleetwood; Royal Sussex County Hospital – Brighton Kemptown). As a result, local electorates may be concerned about the standard of care they can expect in these hospitals.

Three of the hospitals (Bedford Hospital – Bedford; Chase Farm Hospital – Enfield North, and Watford General – Watford) were amongst those flagged by the National Audit Office as belonging to NHS Trusts running deficits in excess of £10m in the last financial year: these are amongst the highest in the country. Uncertainty surrounds the financial sustainability of the hospitals.

A further two (George Eliot Hospital – Nuneaton; Ipswich Hospital – Ipswich) have been referred to the Health Secretary by the Audit Commission owing to concerns over aspects of their financial governance: well-run hospitals need sturdy finances and serious questions are raised by a hospital that is not able to demonstrate financial competence.

Incumbent MPs will be keeping their fingers crossed that these hospitals will improve in the coming months; more than this, they will need to engage with voters on how the party’s vision for the NHS can ensure that the longer-term prognosis of these vital local services will improve.